Up to 40,000 dying patients per year have had "do not resuscitate" orders put on them without their families' knowledge, it has been revealed. The national audit by the Royal College of Physicians shows that out of the 200,000 patients issued with the orders, one in five families were not informed about the secret orders.

The study, which extrapolated its figures from a sample of 9,000 patients, also showed that there was no conversation the dying patient about the order in 16% of cases. Professor Sam Ahmedzai, chairman of the audit told the Telegraph that doctors needed to be more open with patients facing death.

"When a decision has been taken, it is unforgivable not to have a conversation with the patient – if they are conscious and able or with the family. If a doctor was dying they would expect this. We need to show the same respect to our patients," he said.

The procedure whereby food, fluid and medication was withdrawn from patients about to die with abolished in 2014.

The Royal College of Nursing (RCN) has said there have been "abominable" failures in end of life care, with Amanda Cheesley, RCN lead nurse for end-of-life care, telling the paper: "You have to be a decent human being to look after people who are dying. A lot of this is about common sense - about what would you do instinctively. And we've terrified nurses into not doing things instinctively."

A spokesperson for NHS England said the audit showed some improvements.

He said: "Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received across hospitals and areas where improvements must continue to be made."